Comparison of 2 approaches for left atrial myxoma excision: Outcomes and safety

Cardiac myxomas are the most common primary benign cardiac tumors, with approximately 75% located in the left atrium (LA). The optimal surgical approach for LA myxoma excision remains controversial. This study aims to compare the uniatrial and biatrial approaches in terms of safety and outcomes.

We retrospectively reviewed 157 consecutive patients diagnosed with LA myxoma over a 24-year period. Patients were divided into uniatrial (LA group) and biatrial groups on the basis of the surgical approach to compare outcomes.

There was no statistically significant difference between the 2 groups in mean age (P = .61), gender distribution (P = .72), clinical presentation (P = .071), New York Heart Association classification (P = .97), preoperative and postoperative rhythm (P = .83 and P = .20, respectively), concomitant procedures (P = .63), overall postoperative complications (P = .32), re-exploration for bleeding (P = 1), 30-day mortality (P = 1), in-hospital stay (P = .08), long-term survival (P = .42), and recurrence rate (P = .38). However, the mean cardiopulmonary bypass time and aortic crossclamp time were significantly longer in the biatrial group (cardiopulmonary bypass: 81 vs 72 minutes, P = .05; crossclamp: 55 vs 48 minutes, P = .05). Kaplan-Meier survival analysis showed no significant difference in short-, mid- (5-year), and long-term (>10-year) survival rates. Eight cases initially planned for LA approach were converted to biatrial because of technical difficulty.

To the best of our knowledge, this is the largest single-center study on this topic. Both uniatrial and biatrial approaches provide safe and effective resection of left atrial myxomas with comparable long-term outcomes. The biatrial approach offers improved exposure but at the expense of longer operative times. These findings support an individualized surgical strategy on the basis of tumor characteristics and intraoperative exposure.